OBJECTIVES: Evaluate economic burden among Illicit-use opioid overdose patients with and without respiratory comorbidity not on medication for opioid use disorder (MOUD).

METHODS: This retrospective analysis used anonymized Commercial, Managed Medicare, and Medicaid patient claims from the US Optum database. Illicit-use opioid overdose patients without an opioid prescription, with respiratory co-morbidity (RIOP) and without (IOP) in the pre-index period between Jan 2016–Dec 2019 were identified. Patients >18 years at index, with a minimum continuous enrollment of 365 days pre- and 365 days post-index event date were included. Patients on MOUD treatment prior to the index period were identified and excluded. RIOP and IOP by insurance, on naloxone, state, comorbidities, and costs were analyzed.

RESULTS: 845 RIOP and 5,633 IOP were identified. Overall, 61.30% of RIOP were >50 years, 51.36% female, 56.45% Caucasian, and 68.28% had Medicaid. States with the highest RIOP included NJ (14.56%), MD (8.28%), TN (7.81%), OH (7.22%), and NY (6.51%). Overall, 73.92% of IOP were <50 years, 60.59% male, 62.38% Caucasian, and 76.07% had Medicaid. States with the highest IOP included NJ (12.87%), OH (11.54%), MD (10.74%), PA (6.73%), and TN (6.30%). The average index event costs and Charlson Comorbidity Index (CCI) score for RIOP and IOP were $7,280.79 vs. $4,502.22 and 2.60 vs. 0.77, respectively. Index event costs with and without naloxone for RIOP were $2,489.72 vs. $7,771.33 and for IOP $2,026.95 vs. $4792.62, respectively. Based on conservative estimates, the cost difference in treating 100,000 RIOP and 100,000 IOP with or without naloxone demonstrated annual plan savings of ~$528 and ~$276 million, respectively.

CONCLUSIONS: With the higher CCI scores, RIOP had higher costs. Both RIOP and IOP demonstrated significant economic burden, while naloxone recipients had lower costs. Future research should explore naloxone co-prescribing benefits among these patients.